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Post by agedhippie on Feb 12, 2024 17:12:51 GMT -5
That is pretty much the playbook; keep diluting until you get a lucky break. This is a naive take and assumes that CEOs have a victim mentality with no proactive/strategic planning. It’s surprising as you usually have well thought-out arguments, whether I agree with them or not. You can proactively plan and strategize, but without funds it's really just keeping your head above water. These are zombies, they remain alive, but can only scrape by and growth is sketchy at best. When you find yourself in that position dilution is the go-to strategy.
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Post by agedhippie on Feb 12, 2024 17:08:52 GMT -5
Don't we have 3 trials going on now? I sure hope they provide some real data. The problem is its going to take a lot more than great data. If we need more trials we should do them too but we need the political clot as BP will do everything possible to marginalize afrezza. BP absolutely doesn't care about Afrezza, they stopped care once Sanofi dropped it. Even at 50k prescriptions that's only about 1/10th of the RAA market and less than the old human insulin market share. They are not even getting out of bed for that! The idea that there is BP conspiring to suppress Afrezza is the story people tell themselves to justify why it has performed so poorly. It's not the politics that's stopping Afrezza, it's the lack of compelling trial data.
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Post by agedhippie on Feb 12, 2024 16:53:31 GMT -5
You can neither spend your way to prosperity nor save a company from bankruptcy based solely on dilution. You have to have a plan (that will work) and execute on it. There's not a CEO playbook which says "dilute, and everything falls into place". That is pretty much the playbook; keep diluting until you get a lucky break.
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Post by agedhippie on Feb 12, 2024 16:46:16 GMT -5
Companies file all sorts of rubbish as patents and if you want to know why look at what UTHR managed to do to LQDA with a pile of invalid patents. Try typing Mark Cuban insulin into Google. That should help. Ah. Cost Plus Drugs has discontinued the insulin program. It was a pilot, Ginger Viera wrote about it, and the problem they hit is that while they could hit the $35 target for the insulin itself the shipping and handling added another $65. The comment from the Cost Plus Drugs CEO sums up the situation, " We did actually bring one to the market, we did it as sort of a closed beta pilot to see what consumer response would be. But ultimately, direct to consumer mail-order it was $35 for a month's supply but $65 for the shipping and handling. It didn't quite make sense within our model. We almost viewed it as a solved problem from the consumer perspective at this point. You know, almost everyone has access to $35 insulin in one form or another now." Which insulin? I forget but thats when I told him he had no idea what he was doing. I guess I was right. At the time he was running around on all these talk shows saying how he was going to solve the insulin cost issue. I do think he did believe at the time what he was saying. I also think Cuban as a partner would help, a lot. Even if it was $99 versus $35 on costplusdrugs.com with no insurance hassle and Mark running around again with his hair on fire this would be huge. Just search on mark cuban and insulin, you don't need anything else and you will get lots of hits. I think they know exactly what they are doing; read the quote. Insulin is off the table.
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Post by agedhippie on Feb 12, 2024 14:30:21 GMT -5
.. I am not sure I understand what you are saying "So having people without insurance buy Afrezza for $70 per month (two boxes) will somehow force insurance to cover Afrezza? Why? Besides, they can go to Mark Cuban and pay less via his insulin program." Forget the insurance. At the $35 sales price no one needs insurance. The just buy direct from MNKD. The last I heard from Cuban he had no deal with MNKD for afrezza. If I go here costplusdrugs.com/medications/ and enter afrezza I get nothing. In fact if I type in insulin - I get nothing. I told him $35 insulin was already offered at Walmart and "All insulins are not the same". ... Companies file all sorts of rubbish as patents and if you want to know why look at what UTHR managed to do to LQDA with a pile of invalid patents. Try typing Mark Cuban insulin into Google. That should help. Ah. Cost Plus Drugs has discontinued the insulin program. It was a pilot, Ginger Viera wrote about it, and the problem they hit is that while they could hit the $35 target for the insulin itself the shipping and handling added another $65. The comment from the Cost Plus Drugs CEO sums up the situation, " We did actually bring one to the market, we did it as sort of a closed beta pilot to see what consumer response would be. But ultimately, direct to consumer mail-order it was $35 for a month's supply but $65 for the shipping and handling. It didn't quite make sense within our model. We almost viewed it as a solved problem from the consumer perspective at this point. You know, almost everyone has access to $35 insulin in one form or another now."
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Post by agedhippie on Feb 12, 2024 14:09:51 GMT -5
This is a lot less uncommon than you would hope. It also happens in the other direction as some Type 2 variants can put you into DKA (typically this is a "can't happen" for Type 2). I know people who were originally diagnosed as Type 2 but where really Type 1 or LADA (aka. Type 1.5).
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Post by agedhippie on Feb 12, 2024 13:57:40 GMT -5
... The problem with the GLP1s is they are drugs for life. You just can't stop because then you gain the weight back or more. Have you seen John Goodman lately after stopping Ozempic? So no its a combination of several issues including cost and nausea. Part of the issue is their A1Cs have dropped below the "Diabetic" range so they lose insurance coverage. Now thats a target market for Saxenda DPI - offered at a low price - lets say $99. After they have done the heavy lifting with Ozempic and Mounjarno they switch to Saxenda for maintenance which has less nausea and costs a lot less. I tend to trust Stevil as he is actually treating patients with GLP-1, and he says his patients rarely stop because of nausea and that it's mostly gone after the first month or so. The cost issue though is real and why, although it is a drug for life, it is not necessary to continuously take it (as with the UK NHS). Why swap from one GLP-1 analog to another, especially if one like Saxenda with a higher dropout rate.
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Post by agedhippie on Feb 12, 2024 13:00:57 GMT -5
IMO - its really worth listening to this interview with Calley Means. One thing he said is the open secret is the BP commercials are not about selling product to the end user. As we all know scripted drugs require a doctor to subscribe and Calley said the doctors are already paid to subscribe. He said the purpose of the commercials is to pay off the networks so their news coverage is favorable to these drugs. How much bad coverage have we seen on GLP1s - yet 50% stop using within a few months due to issues? That seems like news. tuckercarlson.com/the-case-against-ozempic/If that's what Cally is saying I glad I didn't bother to watch. No doctor I know is paid to prescribe a drug, that is a criminal offence amongst other reasons both for them and the drug company, but really it's because they prescribe what they believe is best. That isn't going to sell books though. Drug advertising is about familiarity rather than direct sales, the same as car advertising. And drug companies advertise on networks because them competitors do and you don't cede mindshare if you can avoid it. Ever considered that people stop using GLP-1 when they hit their target weight? It's not cheap out of pocket. That is the specific pattern the NHS uses with GLP-1 for weight loss, they withdraw it as soon as you hit target or plateau.
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Post by agedhippie on Feb 12, 2024 12:50:03 GMT -5
... The 2 year $35 sale to grow the use base we can do today and sell direct. Nothing is stopping a PR tomorrow. As far as GLP1s, their analogs and insulin. The way insulin and insulin analogs work is vey much different than how GLP1 analogs work. With insulin analogs its about speed and absorption. Not so with GLP1 analogs. ... So having people without insurance buy Afrezza for $70 per month (two boxes) will somehow force insurance to cover Afrezza? Why? Besides, they can go to Mark Cuban and pay less via his insulin program. " The way insulin and insulin analogs work is vey much different than how GLP1 analogs work." No, it's exactly the same. A basal insulin like Iodec is modified to slow absorption, a GLP-1 analog is likewise modified to slow absorption. I suspect you are thinking of RAA rather than basal. GLP-1 suffers from extremely fast clearance so it is necessary to modify GLP-1 producing an analog that, like the basal insulin analogs, slows that process. I seriously doubt Mike doesn't know about the GLP-1 trial as MNKD filed that patent. I also doubt that as a pharmacist who deals in drugs and their behaviors he also knows that the trial used GLP-1 and not GLP-1 analogs and hence is meaningless. He has been crystal clear that they are not going anywhere near GLP-1.
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Post by agedhippie on Feb 11, 2024 23:09:28 GMT -5
... Announce a 2 year sale on afrezza and combine that with kick starting the Saxenda DPI trial. Thats the business plan Mike should start putting together tomorrow. ...He also thinks Saxenda DPI would have no clinical benefit when out of the gate there is no shot and we have a cool inhaler. Moreover, the phase 1 results thought just the opposite and cited several potential clinical benefits. At the right price we are looking at a super blockbuster. A 2 year sale gets you absolutely nowhere. No insurance company is going to take it as it doesn't make financial sense - the price will go up a lot in two years, and they are going to upset the people selling them GLP-1 which will put up their costs. From a diabetic view point why swap since there will be no insurance cover so you have to learn another insulin after which the price goes up - that looks like a bait and switch. You are missing something that Mike as a pharmacist understands; GLP-1 and Saxenda, a GLP-1 analog, are different drugs so the phase 1 trial result is irrelevant. It's like expecting Afrezza and Iodec, an insulin analog, to behave the same - not happening and Mike knows that.
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Post by agedhippie on Feb 10, 2024 20:44:44 GMT -5
I think thats a fair list. In seven years not much has happened except screw-ups. We have sent out wave after wave of sales reps only to not be able to sell the product. Why is that? I will tell you. Its three things; the label; the SoC; and the cost. OK have we 1. fixed the label - Nope 2. fixed the SoC - Nope 3. fixed the cost - Nope Lets be fair, he has managed to increase the number of shares from 95M when he joined to 269M at the last 10Q
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Post by agedhippie on Feb 7, 2024 18:01:16 GMT -5
... I really think just announcing a trial with a big fat press release and doing all the shows including the View would be a positive for the pps. Of course I would put afrezza on sale and talk that up with the lady's on the View. Has Mike ever done any shows? Al use to be on the business shows a bit. Contrary to what I may periodically feel Mike is not an idiot. I can tell you exactly how that idea plays out; if the share price popped on the PR it would collapse when it was clear this wasn't progressing at which point you will have burnt any credibility you have with the market who will be out for blood. The worse case, and why I said "if", is that the market doesn't believe you can deliver since the only drug you have produced is Afrezza which has not exactly been a blockbuster and the price doesn't pop, but does still get hammered for not delivering. Seriously, MNKD would need to be as dumb as a box of rocks to push a non-existent product.
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Post by agedhippie on Feb 6, 2024 17:15:56 GMT -5
The Afrezza co-pay (not per box) is $35 on Medicare where it is in the Plan D formulary. The actual amount MNKD gets is far higher though and is negotiated between the Part D insurer and MNKD. There is a rather weird rebate system between the Plan provider and CMS. My guess would be that the cost to CMS is about the same as to a commercial insurer. Unfortunately I cannot explain exactly how this works since I have never found a full breakdown. There are to many possibilities for me to guess why the $99 offer was withdrawn, but I would love to know for curiosity sake. Is CMS not footing some of the bill? If we can sell commercial for $100 I would think MNKD could offer it for $100 to Medicare but I am sure there is some scheme preventing this. The Part D cost on Medicare.gov is usually around $1200. The insurer is acting as a PBM for Medicare and defines the formulary which is a subset of the Medicare approved drugs. If they want to override the PBM, as with the $35 insulin cap, then they foot some of the cost of that, but not nearly enough to eliminate the cost difference between Afrezza and RAA hence Afrezza doesn't make it into the formularies.
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Post by agedhippie on Feb 6, 2024 17:09:25 GMT -5
"Did you ever consider maybe they don’t detest the “asset” as much as how it has been managed? Or that they still believe in the right hands it could have great value? Or that they believe the price has been beaten down so low it would be the wrong time to sell? Or any and all of the above…" Let me ask, do you believe the insider transactions have caused the drop in SP or, do you think, after MC brought this company back from the brink of near bankruptcy with only enough cash for 1 quarter and the SP hitting low sub $1 he's suddenly lost his fiduciary obligations because he pre-planned his sells, filed the regulatory documents with the SEC in order to exercise his options as the owner to dispose of his earned MNKD shares? Does he lose that right as a CEO or, do we just default to the old "it's the optics of it" that are the problem? Optics are not even a problem. In my experience there is zero expectation amongst the big traders that any CEO will never sell shares. There is also relatively little expectation that they will buy them either beyond those they can get cheaply. If the CEO does buy then it's viewed as the CEO trying to prop up the share price. MNKD's chart is a more volatile version of UTHR's chart - this is nothing to do with the CEO for once.
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Post by agedhippie on Feb 6, 2024 9:38:53 GMT -5
One last point and then I will stop sounding like the broken record on why afrezza's price needs to be reduced to around $35. The $35 price is what MNKD is already selling it on Medicare for so this is not something new. If I remember correctly Mike was so excited about the script increase from Medicare but it requires that crazy pre auth process. How much MNKD is making from this and who is getting paid with this PBM scheme maybe Aged can explain. MNKD is also already selling for $100 commercially but you need 3 denials from insurance to get it. This is crazy too and few doctors want to do the paperwork. I have no idea what happened to the $99 deal but I would sure like Mike to explain this one. The Afrezza co-pay (not per box) is $35 on Medicare where it is in the Plan D formulary. The actual amount MNKD gets is far higher though and is negotiated between the Part D insurer and MNKD. There is a rather weird rebate system between the Plan provider and CMS. My guess would be that the cost to CMS is about the same as to a commercial insurer. Unfortunately I cannot explain exactly how this works since I have never found a full breakdown. There are to many possibilities for me to guess why the $99 offer was withdrawn, but I would love to know for curiosity sake.
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